Home Visit & Medications

Most people know that it is bad when medications prescribed by a physician are not taken as prescribed. It is equally as bad when a physician prescribes new medications without knowing that their client hasn’t taken their current medications properly. It only gets worse when a physician prescribes medications without knowing what another physician has already prescribed.

There can be many moving parts in this process. It is not something that can be blamed on the physician or the patient in most cases. What is for sure is that a skilled nurse can spot these medication mistakes during a home visit.

For example, I drove to visit a new client for medication management a couple months ago. He had been spending all his energy working to get healthy after a spinal stroke. His understanding of his medications was not good.

When I arrived he had two different lists of medication in his home. The lists had problems which I recognized immediately. For one, three different antidepressants were prescribed. He also had multiple pain medications and muscle relaxers prescribed. And last, he was missing three medications.

I spent the next two weeks calling and faxing his doctors and pharmacy. I was trying to straighten out his lists by confirming each medication on the list. It took two weeks because I would have to wait 2-3 days for each response after faxing or calling with a request. When it was all finished, I sent a copy of the revised medication list to both of his doctors and to his pharmacy.

I know this will happen again. The medical system that he is connected to is too busy to see him as important. He is not the kind of patient that will create a fuss to get noticed. It is just a matter of time before one of his doctors or his pharmacy overlooks his needs.

It will be a change in insurance coverage, or a change in his condition that will most likely cause the next problem. Good news for him, he has a skilled nurse making home visits who will be watching for problems if they arise.

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Wealth of Knowledge

It is a very well documented thing that as baby boomers retire they are taking a great wealth of knowledge, wisdom and leadership skills with them. Recently, I had one of those boomers, a daughter-in-law of a client, email me on the weekend asking me to call her on Monday. She had concerns to talk about.

I remember grinning to myself and put a reminder in my phone for Monday afternoon. This kind of interaction is something we invite at Care N Assist. When our clients and their caregivers feel like they can call, I get excited. It’s their respect I want to earn, and that can only be earned when you can talk about both compliments and concerns.

Most of our clients or their family members give us good information. It’s up to us to interpret their message and to find its usefulness. If we start spewing out excuses or fail to listen we are missing out. The value of their comments and the lessons they teach are worth our time.

Most of this generation’s problems are not new. Technology has changed many things, but it doesn’t change the human condition. How we relate to each other and the effort we put into our work does not change. We are fortunate, that in our business we can learn from our clients. Many of them are eager to share their opinions.

I would say that very few of our clients or their family members would qualify them selves as leaders. It’s the combined knowledge and experience that grabs my attention. Their comments are often worth their weight in gold. We just have to take the time to listen.

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Care N Assist Ranks No. 2498 on the 2016 Inc. 5000

NEW YORK, August 17, 2016Inc. magazine today ranked Care N Assist NO. 2498th on its 35th annual Inc. 5000, the most prestigious ranking of the nation’s fastest-growing private companies. The list represents a unique look at the most successful companies within the American economy’s most dynamic segment— its independent small businesses.

Daniel Story, CEO of Care N Assist said, “I was thrilled when I heard we made the list. We are growing, and it is because of our commitment to having a culture of caring. Its more than kindness, it sets us apart from our competition as a company who sees our client’s passion for being able to live at home and gets to work making that possible.”

The Inc. 5000’s aggregate revenue is $200 billion, and the companies on the list collectively generated 640,000 jobs over the past three years, or about 8% of all jobs created in the entire economy during that period. Complete results of the Inc. 5000, including company profiles and an interactive database that can be sorted by industry, region, and other criteria, can be found at http://www.inc.com/inc5000/list/2016/.

“The Inc. 5000 list stands out where it really counts,” says Inc. President and Editor-In-Chief Eric Schurenberg. “It honors real achievement by a founder or a team of them. No one makes the Inc. 5000 without building something great – usually from scratch. That’s one of the hardest things to do in business, as every company founder knows. But without it, free enterprise fails.”

Care N Assist has contracts with State agencies, and has Preferred Provider agreements with the Veterans Administration, Long Term Care insurance and Auto Insurance companies. These contracts give us a broad range of services to our potential clients and a great resume.

Stacey Zsigo, RN, COO says, “We only hire people that I would be comfortable sending to my own grandmother’s home.” Our Care Connects program makes matching each client to a Home Care Aide smooth as we pay attention to our client’s values and passions along with their need for support services. This program along with our specialized trainings and in-services make us an Elite In Home Care Team.

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Every time I am in a client’s home I have to talk to them about things they don’t like to talk about. It just happens most people don’t like to talk about having to go to the hospital, or worse, dying.  So as I go about creating or reviewing their emergency procedures, I end up having to make them uncomfortable. Since I don’t like making people uncomfortable I have created my own way of asking these questions.

The most important of these questions being, “Do you have a DNR, Do Not Resuscitate, order or would you like us to do CPR, Cardio Pulmonary Resuscitation?” Most people are intimidated by such a question. They start talking about their living will or Medical Durable Power of Attorney. I usually thank them for sharing this information, note it on my tablet, then I redirect them to a simpler question.

I don’t use big words or mention what is legal or not legal without a doctor’s order. I simply ask what they would want us to do. It goes like this, “What would you want my Home Care Aide to do if you fell and were hurt?” Unfortunately, many of the people I meet have experienced falling and being hurt. This is often the reason they call Care N Assist and ask for help.

Most, are quick to say they want us to call 911, or press their Emergency Pendant. They will pull the pendant out of their shirt or show me the base unit sitting on their counter. Once in awhile I will have someone say they want their son or daughter called first.

If they haven’t thought about this question before and don’t have a firm answer, this gets the ball rolling in the right direction. If they say “call family” I know they are less likely to want aggressive treatment. If they say emphatically to “call 911” I know that they are probably going to agree with a majority of my clients who want as much help as is possible.

So I proceed with the real question, “What if something else happened? What if you stopped breathing or your heart stopped and you collapsed?” I have gotten such a variety of answers from this question. Most will tell me they want our Home Care Aide to help if they can. If they say this “Yes 911, and Yes CPR” is what I write on their Care Plan.

Having just sat through another CPR training class with our Home Care Aide’s, I’m happy to say they are ready to help if needed. As our CPR trainer, Mike Bussing, always says, ”You can give that person one more Thanksgiving or Christmas with their family.”

Some of our clients will respond, “No. I don’t want CPR,” or “I have a DNR Order.” They usually have a good reason for having this opinion. For some it is a practical reason like having osteoporosis and a small frame, which would make recovering after CPR very painful. Others choose this because of illness or they believe they have lived a full life. In this case I document in our Care Plan, “Yes 911, and No CPR.”

If this is the case, I explain how it will work. We will not perform life saving CPR, but we will have to notify the proper authorities which means calling 911. Simply put, Emergency Medical Services, EMS, will show up and will be obligated to do CPR when they arrive unless they are shown a copy of a DNR order. Having this posted on the refrigerator makes it easy to find in an emergency.

Sometimes when family members are present during the consultation, they will question their loved one’s decision regarding CPR or DNR. This can be a good thing because what my client wants or prefers should be clarified before a situation happens. I am a strong advocate for my clients’ wishes to be written in the Care Plan and ensuring it will be carried out by my Home Care Aide. Having said that, I remind the client and family that I update Care Plans every 3 months or so to give them an opportunity to discuss things further.

Last, I do have clients who want “No 911, and No CPR” documented in their Care Plan. Usually this means Hospice is involved in their care. In place of calling 911 we will call the hospice nurse. This can be a great support service since everything is planned and organized to be taken care of without fail.

I enter every house knowing I have to ask these questions. I never know what a new client will say. A few of them will surprise me. Most of them are happy to hear we have regular CPR trainings with our employees. My job is to keep things simple and document clearly what their wishes are. It will be our Home Care Aide that will be responsible to help when that time comes.

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Stuck in Park

The lady I met yesterday lived in a lake house. She was bruised from a recent fall, and spoke but would get stuck on her words. Her daughter was quick to tell me that she was not suffering from dementia, she just has difficulty getting the words out.

A three-wheeled walker sat across the room from her as she sat in a patio chair with arms on it. As I sat on the couch she quipped something about me sinking in and the couch swallowing me up. I smiled back at her without saying anything about my own battle with being able to stand and walk.

Because of her difficulty getting up and off of furniture her daughter had the entire house retrofitted. She had wheelchair and walker access to the kitchen, bathroom, and bedroom areas without any barriers. She had also planned to go shopping for lift chairs within the week.

This isn’t the first client with Parkinson’s Disease that I’ve met this month or this year. Neurological disorders like this have a tendency to feel like a prison sentence. I don’t want to be overly dramatic, but if your brain is unable to get signals to your muscles it can feel like you are stuck in park and unable to get going.

The tremors that often accompany this disease get worse with movement. The ability to swallow often grows slow and drooling can be a constant difficulty. When movement is easy you can enjoy activities, but only knowing that in a moment you may again be struggling. Falls can be frequent and unavoidable. It is important to understand it is not due to weakness. It is due to the lack of communication between the client’s thoughts and the relays that signal muscle movement. It’s like trying to put the car in drive without having the proper lubricant in the transmission. It locks up.

The medication used to treat this disease does not cure it, but should relieve the symptoms. There are several medications used by doctors to help with symptoms, but the most common treatment is with Carbodopa/Levodopa. This medication has a short half-life, or short (3-4 hour window) time acting in the brain. Once taken most people feel the effects in 15 minutes and have to plan on their next dose because they will also feel their movements slow as the medication leaves their system.  

I tell our HCA’s, to avoid hurting themselves, be very patient. Allow the client to do as much as possible on their own. Use a count before assisting with a transfer so that the client is not stiff and resistant to the movement causing you to strain.  I give them permission to start and restart each movement in order to maximize the client’s abilities.

As caregivers and nurses it is easy to run low on patience. This particular group of client’s really need us to find a way to re-fuel and take our time with everyday tasks. Their health and wellness depends on them being able to maximize their good days. So, give them what they need. Patience and kindness as they get the gears turning and work through the moments where movement seems hard.

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Who Is The Hero

When I walk into a new client’s home it can be easy for me to look around and think… “Same story, different house.” The story goes a little like this. A relatively healthy person gets sick or has an injury. They hold out as long as possible before asking for help. When their needs exceed the limits of their available volunteer support they call us (or their caregiver calls us.)

When I go to meet with the client and their caregiver, I know that I am not a very important player in their story. They will grow much closer to their Home Care Aide, HCA, than they will to me. A few of them will realize that they are talking to the company owner and appear to give me their respect for gracing their home. Others will ask questions like… “Why are you seeing clients?” I can only say, “Its what makes me happy.”

It is really not about me though. I offer my expertise. I know how to ask questions and how to solve many of their problems, but once this is done it will be other hands who will guide them and care for them in their life story.

Our Staff Coordinator will use our Care Connects system to find the appropriate HCA. Our Office Manager or Administrator will agree or disagree and call the best possible HCA in to discuss the client’s needs. An introduction will be arranged under the best circumstances and the HCA will meet the client for the first time. First impressions being what they are… we hope everything will go well and we have inserted a great supporting character into the life story of our client.

A really good HCA knows that they are also playing a supporting role in a client’s life story. A few of them think that they should be the hero, but the best HCA’s have a way of making their client’s feel like they are the main character and hero in their own story. The client’s ability to find a happy ending should be the result of calling on us to help them to rise to the challenge of this chapter in their life.

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Love To Walk

I am an amputee, and when I don’t have my prosthetic on, I am at a disadvantage. It’s hard for me to remember running races or being able to play kick ball or even stepping up a curb without stopping to adjust to the terrain. People who know me can attest to the fact that I always have my prosthetic on. I walk. I move myself every day, because I love being able to walk.

Mrs. James is a client I met almost a year ago. It broke my heart when I heard her say that she has been in a wheelchair for six years. Her life has been changed because she is not able to stand and walk more than a few steps. Her problem started after a surgery. Pain kept her from getting up and moving. Since she hasn’t walked in such a long time she has become weak and uses a wheelchair.

Lets take a walk down memory lane. When was the last time you stumbled while walking? I often hear people joke about having two left feet, or the ever popular, “did you see that crack in the side walk jump up and grab my foot?” If you hear yourself or someone else say these things frequently then its time to pay attention. Most people can use a device to make walking easier or safer. Others need more intense action.

Being able to walk is taken for granted by most of us. From the moment we take off on two legs as a toddler till we have something happen that threatens that ability. There are a few things that can be done to improve or regain the ability to walk.

The first step, is believing. It is important to get your mind made up that you will be able to improve your strength and balance. If you don’t see it happening, then it will impact your progress. It has to become so important to you, that any amount of effort, energy or pain is worth it to you.

The second step, is doing exercises that will impact your ability to walk. There are specific actions that will impact balance and posture and improve the smoothness of your movements. These actions can be assigned by your therapy staff or you can talk to us about joining a free Matter of Balance class. Our Home Care Aides can work with you to help you accomplish your goals as well.

Strength only improves when you do real work. As someone speaking from experience, walking is worth the work. Keep your head up, tighten your core muscles and swing your arms. You may not move fast enough to feel the wind in your hair, but you will go places and see the people that you love.

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